Provider Demographics
NPI:1679163315
Name:BANKS, BRANDON WAYNE (LPC)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:WAYNE
Last Name:BANKS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 SKYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-6260
Mailing Address - Country:US
Mailing Address - Phone:423-620-8867
Mailing Address - Fax:
Practice Address - Street 1:128 SKYVIEW DR
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-6260
Practice Address - Country:US
Practice Address - Phone:423-620-8867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-09-01
Deactivation Date:2021-04-01
Deactivation Code:
Reactivation Date:2021-05-25
Provider Licenses
StateLicense IDTaxonomies
TN5562101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional